Intraoperative cardiac arrest most likely following heavy blood loss

Study results show that although intraoperative cardiac arrest (ICA) is rare during noncardiac surgery, patients who receive intraoperative blood transfusion are at increased risk for the event.

And as the number of transfused units of blood rises, so does a patient's risk for ICA, say Sumeet Goswami (College of Physicians and Surgeons of Columbia University, New York, USA) and team in Anesthesiology.

Compared with study patients who received no intraoperative blood transfusions, the likelihood of ICA was 2.51-, 7.59-, 11.40-, and 29.68-fold higher among those who receive 1-3, 4-6, 7-9, and 10 or more units of erythrocytes, respectively, explain the authors.

In the study, ICA occurred at an approximate rate of seven cases per 10,000 noncardiac surgeries and carried a 30-day postoperative death risk of 63%.

"The high case fatality suggests that primary prevention might be the key to reducing mortality from ICA," say Goswami et al.

The study data analyzed was taken from the American College of Surgeons National Surgical Quality Improvement Program database, in which the intra- and postoperative outcomes of 362,767 noncardiac surgery patients were recorded.

Other predictors of ICA risk identified in the study included emergency surgery and impaired preoperative patient functioning.

In an accompanying editorial, Elizandro Muñoz and Wei Pan, both from Baylor College of Medicine in Houston, Texas, USA said that the latter finding supports the "generally accepted belief" that functioning and physical status affects a patient's likelihood to survive surgery.

The editorialists also praised the study's design.

They said: "Most notable are the large number of subjects, the homogeneity of the sample population, and the fact that the data were prospectively collected."

Goswami and co-authors conclude: "The results of this study may help cardiologists, primary care physicians, anesthesiologists, and surgeons to improve the risk stratification of patients and develop interventions to lower the incidence of ICA in high-risk patients."

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